Alcohol-Related Disease Impact -- Wisconsin, 1988

Based on CDC's Behavioral Risk Factor Surveillance System,
Wisconsin is among the leading states nationally in estimates of
alcohol-related risk factors: in 1988, 25.3% of the adult
population reported binge drinking (consuming five or more drinks
on one occasion during the last month), 8.6% reported heavier
drinking (consuming greater than or equal to 60 drinks per
month), and 6.2% reported drinking and driving (driving after
having "too much to drink" at least once in the last month).
Alcohol sales data for 1984 indicate that Wisconsin ranked sixth
among all states in per capita sales of ethanol (3.2 gallons of
ethanol sold per Wisconsin resident aged greater than or equal to
14 years). To characterize the public health impact of alcohol
use and misuse in Wisconsin, the Wisconsin Department of Health
and Social Services used 1988 mortality data and population
estimates and a structured data-base approach to estimate
alcohol-related mortality (ARM),* years of potential life lost
(YPLL),** and economic costs (1,2).

In 1988, a total of 1949 alcohol-related deaths occurred in
Wisconsin, accounting for 4.5% of all deaths (Table 1).
Intentional (suicide and homicide) and unintentional injuries
accounted for 857 (44%) of these. The contribution of injury
deaths to ARM varied inversely with age: injuries accounted for
97% of ARM among persons aged less than 35 years, 38% among
persons aged 35-64 years, and 24% among persons aged greater than
or equal to 65 years (Figure 1, page 185). ARM due to digestive
diseases and mental disorders was more prevalent in the
35-64-year age group; ARM from neoplasms and cardiovascular
diseases in persons aged greater than or equal to 65 years was
substantial. The absolute number of alcohol-associated deaths
increased with age. In contrast, ARM as a proportion of total
mortality peaked at ages 15-24 years and declined with age
thereafter (Figure 2, page 185).

Males accounted for nearly twice as many alcohol-associated
deaths as females (1263, compared with 686); the greatest
differential (3:1) occurred in the less than 35-year age group.
Sixty-one percent (417/686) of alcohol-related deaths in females
occurred in the greater than or equal to 65-year age group,
compared with 41% (521/1263) in males. Of the 857 alcohol-related
deaths due to injury, 604 (70%) occurred in males, 311 (51%) of
whom were less than 35 years of age. For males less than 35 years
of age, 159 deaths (50% of ARM in this group) were from
motor-vehicle injuries.

The 1949 deaths related to alcohol use and misuse accounted for
an estimated 46,052 YPLL to full life expectancy (23.6 YPLL per
death). Injuries accounted for 30,023 (65%) YPLL; 14,458 of these
YPLL were due to motor-vehicle injuries. Males less than 35 years
of age accounted for 16,011 YPLL, more than one third the total.

Alcohol-related economic costs were prorated from national
figures (national per capita alcohol-related costs multiplied by
Wisconsin population), except for indirect mortality costs, which
were calculated using expected lifetime earnings and Wisconsin
mortality data (1). In 1988, alcohol-related economic costs in
Wisconsin were estimated to be $1.47 billion (Table 2, page 186).
Direct costs (i.e., those for which actual expenditures are made)
were estimated at $344 million. Direct health-care costs for the
detection, treatment, and rehabilitation of alcohol-related
diseases and injuries were $152 million, of which $65 million
(43%) represented short-stay hospital costs. Direct costs of
fetal alcohol syndrome (FAS) were estimated at $34 million; 80%
of these costs were for residential care and support services for
mentally retarded adults greater than 21 years of age whose
impairment was considered to be caused by FAS. Indirect costs
(i.e., potential goods and services not produced because of lost
or diminished productivity) were estimated at $1.13 billion. In
1988, the alcohol-related economic cost per resident in Wisconsin
was $305.
Reported by: NA Akgulian, ME Moss, DDS, PL Remington, MD, HA
Anderson, MD, Div of Health, Wisconsin Dept of Health and Social
Svcs. JM Shultz, PhD, Dept of Epidemiology and Public Health,
Univ of Miami School of Medicine, Miami, Florida. Div of Field
Svcs, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: The structured data-base analysis described in
this report (1) can be used by state health departments to
estimate the magnitude of the health and economic impact of
alcohol use and misuse across many disease categories. Previous
experience has shown that analyses that attribute costs and
disease outcomes to specific risk factors can be used to support
public-health interventions (3). This analysis determined that in
Wisconsin in 1988, alcohol use and misuse was responsible for
4.5% of all deaths, an estimated 46,052 YPLL, and approximately
$1.47 billion of direct and indirect costs. A substantial
proportion of the health and economic impact was related to
alcohol-attributable injuries among persons in younger age
groups.

Although this assessment of alcohol-attributable disease and
injury impact is based on the most current cost-of-illness
methodologies, at least four restrictions apply to the
interpretation of the results. First, the lack of
well-established relative risks for alcohol use and misuse by
age, sex, and drinking pattern limit the precision of the
alcohol-attributable fractions (AAFs). All calculations of ARM,
YPLL, and mortality-related economic costs depend on these AAFs.
Second, indirect costs were calculated by a methodology (4) in
which the value of human life is estimated to be the lifetime
earnings of a person, with future earnings discounted to present
value (a 4% discounting rate was used in this study). Although
this method is commonly used to place a dollar value on human
life, it may underestimate the relative economic value of women
and minorities (4). Third, for costs other than those due to
mortality, national estimates are prorated to the state's
population. Although proration is necessary because state-level
data are not available, this method is insensitive to possible
differences between the state and the nation in patterns of
alcohol use and associated costs. Finally, the psychosocial
effects of alcohol use and misuse (e.g., pain and suffering) are
difficult to convert into economic terms and were not included in
this analysis.

Despite these limitations, this analysis illustrates the
magnitude of the health and economic costs of alcohol use and
misuse across many disease and injury categories and may provide
a framework for public health initiatives to reduce
alcohol-related morbidity and mortality.

Revenues from excise taxes on alcohol are lower than the
economic costs associated with alcohol use and misuse (5).
Increasing state alcohol tax rates represents one potential
approach for reducing alcohol consumption while simultaneously
generating revenue to offset the costs associated with alcohol
use and misuse. These funds could be used to support mass media
campaigns, school-based health education programs, and alcohol
treatment programs to reduce the burden of alcohol-related
morbidity and mortality.

This report also demonstrates that injuries--particularly those
caused by motor vehicle crashes--were a substantial cause of
alcohol-related premature mortality in Wisconsin. State-based
options for reducing the public health impact of drinking and
driving include raising the minimum drinking age, lowering legal
blood-alcohol concentration limits, increasing the enforcement of
"drunk driving" laws, and enacting mandatory motor vehicle
safety-restraint laws.

Manning WC, Keeler EB, Newhouse JP, Sloss EM, Wasserman J. The
taxes of sin: do smokers and drinkers pay their way? JAMA
1989;261:1604-9.
*ARM was calculated by multiplying the number of deaths by the
fraction determined to be alcohol-related for each International
Classification of Diseases, Ninth Revision, Clinical
Modification, rubric.

**YPLL were calculated by adding YPLL (age-adjusted life
expectancy minus age at death) for each of the alcohol-related
deaths.

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